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Health reform: Is childhood dental insurance required? That all depends

teen-dentist.jpg

Inside Dentistry for Teens in Wilsonville. Health insurance policies are supposed to offer pediatric dental coverage, but many don't. And shoppers on Cover Oregon don't have to purchase the coverage separately.
(Doug Beghtel/The Oregonian)

But in Oregon, consumers purchasing insurance through the state's
exchange don't have to buy it. And in Washington, where its purchase is
required if you have kids, federal tax credits won't help offset the additional
cost of the coverage.

Federal law exempts plans on Cover Oregon and other state exchanges
from having to include it in their policies, as long as the exchange offers
standalone dental policies.

Not so in Washington. The state requires anyone with dependents under
age 19 to get pediatric dental coverage, said Bethany Frey, spokeswoman for the Washington Health Benefit Exchange. Five insurers offer stand-alone dental
plans on the state's exchange.

It's a different story for consumers buying outside exchanges,
directly from an insurance carrier. Plans sold off any exchange must offer
pediatric dental coverage as a benefit or get reasonable assurance from
consumers that they have obtained or will obtain such coverage in the future.
Oh, and their coverage must be from a dental plan certified by the exchange.

This has led to a lot of
confusion and frustration among insurance agents and consumers.

Stephen Cohen, a licensed tax consultant in Portland, said he's
decided to drop Providence as his provider after discovering that none of the
carrier's plans offered the benefit.

"They have gone so far as to say that
they won't sell me a plan for my son unless I can prove that I have obtained
the required coverage elsewhere," Cohen said recently. "To me, this is
ridiculous. And, it is a major factor in why I won't be continuing coverage
with them in 2014."

Cohen said he's opting for a plan through Moda Health that includes
child dental coverage.

Kaiser Permanente employs its own dentists. But none of its plans on
the exchange include pediatric dental among its benefits.

Yet another kink comes in regards to the tax credits. In Washington,
for those who qualify, their credit might not cover the pediatric dental
premiums.

Because of a quirk in the IRS new rules, consumers will receive a
lower tax credit in states in which the benchmark silver plan doesn't offer
pediatric dental as a benefit. Washington's benchmark plan doesn't cover
pediatric dental.

In September, Oregon Sen. Jeff Merkley and 13 other Senators wrote
U.S. Treasury Secretary Jack Lew asking him to change IRS rules so tax credits would
increase if consumers bought pediatric dental.

"I think it's something that's going to be addressed as we go down the
road in the future when we start seeing changes to the legislation," said Dr.
Paul Reggiardo, spokesperson for the American
Academy of Pediatric Dentistry.

The differing requirements leaves many questioning why it's a
required benefit in the law... if it really isn't.

"I think it should be left up to each
individual to purchase it as you need it," said Greg Schoenberg, president of
Health Insurance Solutions in Kalama, Wash. "Some plans have it and some plans
don't. That's kind of weird, isn't it?"